Treatment of febrile urinary tract infections caused by Enterococcus faecalis in male patients: A national survey among French infectiologists
Abstract
OBJECTIVES: The management of Enterococcus faecalis febrile urinary tract infections in men (FUTIEfM) is poorly standardized. We aimed to describe current prescribing practices among French infectious disease physicians. METHODS: An anonymous questionnaire was distributed via two national mailing lists between December 2023 and January 2024. The survey explored antibiotic choices, treatment duration, and scenarios prompting therapeutic abstention. RESULTS: A total of 203 physicians responded. Most (98%) reported managing at least one FUTIEfM case every six months. Amoxicillin was the preferred first-line treatment (86%), typically prescribed at 80-100 mg/kg/day (74%); treatment duration was 14 days in 69% and 21 days in 29% of cases. In penicillin-allergic patients, linezolid was the preferred alternative (51%), followed by fluoroquinolones (38%). Fluoroquinolones were deemed inappropriate by 37% of respondents, versus 9% for linezolid and 3% for amoxicillin. Among those considering treatment appropriate, a 14-day course was favored by 81% for linezolid and 92% for fluoroquinolones. Therapeutic abstention was frequently selected in cases of catheterization (51%), polymicrobial cultures (50%), or leukocyturia <10⁴/mL (64%). CONCLUSIONS: High-dose oral amoxicillin is the preferred treatment for FUTIEfM. Linezolid and fluoroquinolones (especially levofloxacin) are also used, though with less consensus. Therapeutic abstention appears appropriate in select clinical scenarios.
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